Who needs who?: Therapist dependency and its impact on the therapeutic relationship: A modified systematic review with clinical illustrations

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Abstract

This dissertation takes an alternative view of dependency in the therapeutic relationship. Instead of viewing dependency as a client problem to be addressed by the omnipotent, healthful, altruistic therapist, this modified, systematic, literature review conceptualizes dependency as a core relational dynamic, common to therapist and client. It is proposed that the tension between strivings for dependency and connection on the one hand and for autonomy and independence on the other, is life long and will be present in the therapy both as material brought by the client and as part of the therapeutic relationship.

The premise is that both client and therapist will bring their own dependency issues into the therapeutic relationship and that this material may be either conscious or unconscious. Five dependency styles are theorized; with successful maturation following a progress from dependency to independency, to a mature dependency. Mature dependency allows the individual, to move freely and appropriately between independence and dependence, separation and connection and is seen as essential for intimate relationships. Co-dependence and counter-dependence are viewed as defensive styles arising out of the frustration of early developmental needs for dependence and separation.

The potential impact of varying dependency styles on the therapeutic relationship is discussed, with particular reference to how counter-dependent and dependent or co-dependent styles may challenge or limit the therapy relationship. It was found that unless therapists are aware of their own dependency issues these may be projected onto clients or adversely affect their clinical decisions. Clinical examples illustrate the points made.

Central to the discussion are the ways in which therapists may be dependent on clients. The potential conflict in acknowledging these dependency needs is explored and the importance of the therapist being conscious of her dependency is stressed.

It is concluded that it is essential for psychotherapists to acknowledge their dependency, both to safeguard the integrity of the profession and to ensure safe clinical practice.